Provider Demographics
NPI:1851115661
Name:SIXTO CABANA, JORGE ALAIN (SURGICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ALAIN
Last Name:SIXTO CABANA
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 SW 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2323
Mailing Address - Country:US
Mailing Address - Phone:786-945-7211
Mailing Address - Fax:
Practice Address - Street 1:9210 SW 68TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2323
Practice Address - Country:US
Practice Address - Phone:786-945-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-505363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical